JMIR Publications

ABSTRACT

Background:

Growing evidence suggests that severe acute coronavirus disease 2019 (COVID-19) illness increases the risk of Long COVID. However, few studies have examined associations between acute symptoms and Long COVID onset.

Objective:

Our objective was to examine associations between acute COVID-19 symptom profiles and Long COVID prevalence using a population-based sample.

Methods:

We used a dual mode (phone and online) population-based probability survey of adults with PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine 1) how acute COVID-19 symptoms cluster together using latent class analysis; 2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties; and 3) associations between symptom clusters and Long COVID prevalence using modified Poisson regression.

Results:

In our sample (n=4,169), 15.9% had Long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified six acute COVID-19 symptom clusters, with flu-like symptoms (24.7%) and fever (23.6%) most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10.0%) clusters. Long COVID prevalence was highest in the multisymptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by flu-like (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs. males) had greater odds of membership in the multi-symptomatic, flu-like, and predominance of fatigue clusters, while adults who were Hispanic or another race/ethnicity (vs. non-Hispanic white) had greater odds of membership in the multi-symptomatic cluster. Compared to the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of Long COVID (aPR 6.1, 95% CI 4.3-8.7), followed by predominance of shortness of breath (aPR 3.7, 95% CI 2.5-5.5), flu-like symptoms (aPR 2.8, 95% CI 1.9-4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5-3.3) clusters.

Conclusions:

Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of Long COVID, including potential mechanistic pathways in a research context, and proactively screening high risk patients during the provision of clinical care.